Extrapolation of current trends is a poor way to think about the future, particularly at times of great change. The best method, according to Ian Morrison, former president of the Institute for the Future in California, seems to be to bring together a diverse group of people knowledgeable about the subject of interest, provide them with good data, and ask them to imagine a series of possible scenarios. Earlier this year Andersen Consulting, the world's largest management consulting firm, invited 25 people from different parts of health care and from 10 countries to Singapore to consider how the world's healthcare systems might develop.

The group was particularly interested in what part “managed care” might play. The World Bank has argued that it has much to offer internationally, and many American managed care organisations have already begun to operate outside the United States. One of the main conclusions of the meeting was that the whole system of managed care (if there is such a thing) had little to offer but that the many tools of managed care (see box) had much to offer most healthcare systems.

Some tools of managed care

Managing demand

Capitation

Gatekeepers

Advice lines to patients

User fees

Consumer education

Medical management

Review of use

Preadmission

certification

Disease management

Greater use of guidelines

Care delivery

Telemedicine

Greater use of non-doctors

Although every healthcare system is different, they can be grouped into four “archetypes.” Socialised medicine (as in Britain or Sweden) covers everybody, has a single payer, and usually has those who provide care salaried or capitated (paid so much for every person for whom they provide care). Socialised insurance (as in Australia, Canada, or France) also covers everybody and has a single payer but pays those who provide care a fee for each service. Mandatory insurance (as in Germany, Brazil, Japan, Malaysia, and …